1552 /o POO
COT NO.
NO. STRE�
rP �ONe E .APPLIANCE PERMIT
�j 0 C VF CUPERTINO
M ti OCT 2 9 1963 =M ',
V r Date 196..... - Permit No. Z. 5 ��
� CITY OF CUPERT'''" Fees
Application is hereby made to the City of Cupertino for a per (G 3�
gas appliances as listed on the reverse side hereof, and agrees to installd S—
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
u
Use of Premises le
u
h Owner
Address,_
By a �� Address
W'r NTRACfOR, AGENT `-
n Phone �� Approve }
ry — PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges I II I
Wall Heaters I I I I I
Gas Plates I I I I
Circulating Heaters I I II
Blower Furnaces ,Od
Gas Fired Boilers I I I
Warming Ovens I
Percolators I II
Griddles
' Steam Tables I II I
Gravity Furnaces
,6j Suspended=Unit II I
Floor Furnace
[� co
Miscellaneou
(NAME TYPE) I 1//SCI
v oll I
s
pp lance ees
Inspected and Approved ....... . .... .. ... ..................V.....................
TF. INSPECTOR
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